Provider Demographics
NPI:1083060560
Name:HYPERBARIC CENTERS OF SOUTHWEST FLORIDA, LLC
Entity Type:Organization
Organization Name:HYPERBARIC CENTERS OF SOUTHWEST FLORIDA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BOB
Authorized Official - Middle Name:
Authorized Official - Last Name:CREDEROTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-726-5331
Mailing Address - Street 1:4458 BEE RIDGE RD
Mailing Address - Street 2:UNIT # 18
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-2502
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4458 BEE RIDGE RD
Practice Address - Street 2:UNIT # 18
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-2502
Practice Address - Country:US
Practice Address - Phone:941-726-5331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-13
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Multi-Specialty